Abstract
Due to the constantly improving results of surgical revascularization for coronary heart disease even the elderly patients are offered more frequently this type of treatment. Since older age is a harbinger of reduced vital capacity and increased morbidity the results of coronary artery bypass grafting (CABG) in elderly as well as long-term benefit deserve a careful examination. 1475 isolated CABG procedures performed between 1995 and 1997 in a university hospital cardiac surgery unit, divided in group I (age below 70, n = 1324) and group II (age 70 and over, n = 151). A retrospective analysis of pre-operative, peri-operative and post-operative data. Significant differences (lower BMI and BSA, advanced NYHA and CCS stage, higher prevalence of diabetes, renal dysfunction and extracardial atherosclerotic lesions) were found in elderly. CABG was performed in both groups with no differences in technique of procedure (only slightly longer duration of CPB in group II). However, there was markedly higher mortality (2.3 vs. 7.3%, p < 0.005), incidence of NearMiss+ (18.4 vs. 36.4%, p < 0.005) and post-operative morbidity (34.6 vs. 56.3%, p < 0.005) in the older group, which was also expressed in a longer ICU stay and postoperative hospitalization. Coronary revascularization can be performed in elderly with higher but still acceptable risk. Higher mortality and associated morbidity is caused by higher preoperative prevalence of known risk factors as well as generally reduced vital capacity. Surgical procedure should not be denied to elderly population because of the age alone but a careful evaluation of an individual patient is required.
Highlights
Coronary revascularization for ischaemic heart disease is a well established method capable of effective relief of symptoms of ischaemia and improving the long-term prognosis of the patients
Though yielding similar benefits the surgical revascularization in elderly is accompanied by higher incremental risks caused by age-related morbidity and probably a globally reduced vital capacity
The renal dysfunction was present in 19 %
Summary
A total of 1584 coronary revascularization procedures were performed at our cardiac surgery unit in years 1995 – 1997. From this cohort 1475 patients in whom CABG was performed as an isolated procedure were enrolled in the study. These patients were divided in two groups: I – the patients of the age below 70, and II – the patients of the age 70 and older. A complete set of preoperative, operative and postoperative data were analysed. The data were retrieved from the Patient Analysis Tracking System Database provided by Medicon CZ and completed from the patients medical documentation.
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